KAISER PLAN GENERAL DESCRIPTION

In order to enroll in Kaiser, you must live or work within 30 miles of a Kaiser Permanente medical group or facility.

Most covered services will be provided at no charge or will require a small copayment. A Kaiser physician must determine that the services and supplies are medically necessary to prevent, diagnose, or treat your medical condition. The services and supplies must be provided, prescribed, authorized or directed by your Kaiser physician. For a complete description of your benefits, limitations, exclusions, the services covered, any copayments, the conditions or circumstances under which services may be received or denied, and details on the procedures to be followed for obtaining these services, and for the review of claims for services that are denied in whole or in part, please refer to the Evidence of Coverage brochure provided by Kaiser. The brochure will be provided at no cost to you by Kaiser or the Administrative Office.

When you enroll in Kaiser, you must receive services at facilities associated with Kaiser Permanente. A list of Kaiser facilities will be provided to you without charge by the Administrative Office or Kaiser. If you do not receive services at authorized facilities, you will be responsible for 100% of the charges (except in an emergency, in which case Kaiser will determine how much it will pay). The benefits provided by Kaiser are subject to the terms and conditions of an agreement with the Plan.